I’m very worried about my cousin. We grew up in the same house, so I feel almost like a sister to him. I’ve noticed over the past few years that his drinking is becoming more and more of a problem. Whenever we are at a family function or out with friends, he gets extremely drunk. I make sure he makes it home safely but I don’t know what happens when I’m not around. He has gone through two jobs in the past year – I think because he wasn’t able to get up for work. He says he only drinks on the weekends. That might be true – but he drinks so much when he does drink. He is 28 now so he should be over the college drinking years. He doesn’t think he has a problem. I don’t know what I can do to help.

Dr. Norquist responds:

It’s very painful to have a loved one who struggles with substance abuse. It’s natural to worry about his safety, his health, his quality of life, and his overall future. The frustrating part is the fact that it is up to him to change his behavior – you can’t do it for him. The natural response on the part of the loved ones is to step in and be protective; driving him home when he’s drunk, perhaps making excuses for him with his boss, taking care of important life responsibilities that he is not attending to, etc. In the long run, this enables him to continue with his addiction without having to face the consequences.

Substance abuse can be diagnosed if the substance use causes significant “impairment or distress” in one of the following areas: work (e.g., absences, suspension, or loss of job), legal (DWI arrests), risky behaviors (driving while under the influence), or interpersonal/social problems as a consequence of the substance use. Your cousin does meet the criteria for substance abuse. If there is a history of any kind of addiction in his family background (alcohol, drug, gambling, sex, etc.), he is even more at risk for developing a full blown addiction.

It would be best if you could use the compassionate bond you have with your cousin to touch his heart with your concern. When the moment is right, with kindness and non-judgmentalness, express your heartfelt concern. Do not exaggerate, but present the facts as you know them to be. Hopefully this will plant the seeds for him to admit to himself that his drinking is problematic. If he continues to ignore his alcohol abuse, and his addiction progresses, you and your family may want to consult an intervention specialist. Most substance abuse programs have a list of intervention specialists that they can recommend. Hazelton (in Minnesota) and Caron (in Pennsylvania) are two excellent treatment centers that will have a list of intervention specialists. In addition, Al-Anon is a wonderful source of support for the loved ones of those struggling with addictions. Call 1-888-425-2666 (weekdays 8 a.m. to 6 p.m. ET) or www.al-anon.org for information regarding local Al-Anon meetings. He is fortunate to have such a caring cousin!

(Dr. Sallie Norquist is a licensed psychologist (NJ #2371) in private practice and is director of Chaitanya Counseling Services, a center for upliftment and enlivenment, in Hoboken.) Dr. Norquist and the staff of Chaitanya invite you to write them at Chaitanya Counseling Services, 51 Newark St., Suite 202, Hoboken, NJ 07030 or www.chaitanya.com or by e-mail at drnorquist@chaitanya.com, or by fax at (201) 656-4700. Questions can address various topics, including relationships, life’s stresses, difficulties, mysteries and dilemmas, as well as questions related to managing stress or alternative ways of understanding health-related concerns. 2012 Chaitanya Counseling Services